Massive Irregularities Surface in Employee Class 4 Appointments

Fayyaz opens a can of worms and sees another example of institutionalized corruption in the state

(Mr. Ahmed Ali Fayyaz, 49, was born in Bodina, Budgam, and received his primary and secondary education in Budgam and later at Amar Singh College, Srinagar. He completed his Master's degree in Kashmiri language and literature from the University of Kashmir in 1987. After working with Rashtriya Sahara and Kashmir Times in 1993-94, and later for 13 years as Srinagar Bureau Chief of Daily Excelsior, he is woking as Resident Editor/ Srinagar Bureau Chief of Jammu-based English daily Early Times since April 2009. He is also a filmmaker whose forte in audio-visual media is Kashmir's composite culture, heritage, ecology and social issues. Since February 2008, he has been regularly anchoring Take One Television's bi-weekly hard talk show "Face To Face With Ahmed Ali Fayyaz" which is watched by more than three million viewers in Srinagar, Jammu and other urban areas of Jammu & Kashmir.)


After School Education, Higher Education too in the Dock


Srinagar: Officials associated with absorption of Local Fund Employees (LFEs) in different colleges of the state have committed gross irregularities in making Class 4th appointments. While the officials of Department of Higher Education have yet again taken a lion's share of the vacancies and managed to absorb their sisters and sisters-in-law in multiples, those serving in the colleges for 15 to 18 years have been fraudulently shown as 'ineligible' in terms of qualification and dropped only to create room for relatives and bribe paying clients.

Through a notification published in a Greater Kashmir news paper dated February 19th, 2012, Department of Higher Education in Civil Secretariat has declared selection of 130 LFEs for different Class 4th vacancies in different colleges of Kashmir Division. Principals of the degree colleges had engaged as many as 412 for continuing job of class IV employees, in absence of regular staff, on temporary basis in the last nearly 18 years. Their remuneration, which was initially fixed at around Rs 1,000 and gradually enhanced to over Rs 3,000 a month, came from Local Fund of these colleges.

Even as many of those engaged happened to be the relatives and domestic helps of professors and principals, quite a number of them were engaged compassionately and made to work much more than the regular Class IV staff. With many of these LFEs crossing age-bar and working hard, pressure mounted on successive governments to absorb them against substantive class IV vacancies. Minister of Higher Education in Omar Abdullah government, Abdul Gani Malik, took keen interest to ensure that the service rules were changed and 40% of the vacancies were reserved for LFEs.

It was decided that the candidates eligible by qualification on their respective dates of engagement would be selected after verification of their academic record, merit and reserved category, if any, irrespective of their age-bar which ranged between 34 and 37 years in the last 18 years. When the final selection list, under Order No: 50/HE of 2012 dated 17-02-2012 was published by Director of Colleges on February 19th, many of the candidates were taken aback.

One of the candidates dropped, namely Shameema, who is now over 50-year-old and had struggled hard for the reservation and absorption of LFEs, attempted suicide at Press Enclave. Engaged in 1994 and now a grandmother of four children, Shameema has been dropped for being "only Middle Pass". Her argument is that "Middle Pass" used to be the coded qualification for all class IV appoints till 2008. Not only that. The selection list clearly mentions the qualification of five selected LFEs as "Middle Pass". All the five have been engaged years after Shameema was.

Gulshan Ara, engaged on 29-10-1996 at Govt College for Women, M A Road, has also been dropped. According to the published gazette of J&K State Board of School Education (BOSE) and the original certificate she waves to mediapersons, Gulshan Ara has passed her Matriculation examination under Roll No: 872479 in November-December session of 1994. Two of the department's Deputy Directors, who had been deputed by Director of Colleges, for verification of the qualifications claimed by the LFEs, entered into a criminal conspiracy at Govt Amar Singh College recently and eliminated her from all lists for being only "Middle Pass". They allegedly created space for a far junior candidate and got her selected.

This act of criminal conspiracy passed off smoothly inspite of proven honesty and integrity of almost all the higher ups---Minister of Higher Education Abdul Gani Malik, Commissioner-Secretary Hr Education, Tanvir Jehan, and incharge Director of Colleges, Mrs Muqbil Chisti.

In the last leg of the selection process, Director of Colleges sought the latest verification of the LFEs particulars vide her No: EC-Coll/GCET/2011 dated 21-12-2011. Principal of Govt College for Women furnished a signed list vide No: WC/44 Dated 10-01-2012, certifying that Gulshan Ara was a Matriculate when she had been engaged on 29-10-1996 as also when the tentative list was formulated on 09-09-2004. Still the staff from Higher Education Department, as unknown to Gulshan Ara but revealed to Early Times by Director of Colleges Mrs Chisti, mentioned her as "Middle Pass" and got her dropped from the final selection list.

Two of Gulshan's juniors, namely Mubeena Akhtar and Mehfooza Jan, have been selected and asked by the notification to join the regular service within 21 days. All the three belong to 'Open' category and all the three have matriculation as their qualification.

Tentative List, containing 428 names, was made on the cut-off date of 09-09-2004 and published in Greater Kashmir dated 25-12-2009. Under Secretary Dhananter Singh called for objections, if any, within 21 days. With no objection to the three names mentioned hereinabove, Final List was notified by same Under Secretary to Government vide No: EC-Coll/LF/List/2009 dated 04-10-2010 and published in Greater Kashmir dated 12-10-2010.

In both the lists Gulshan Ara figures at Serial No: 81 and her qualification is mentioned as Matric. She is duly shown to have been engaged on 29-10-1996. Principal's letter No: WC/44 dated 10-01-2012, addressed to Director of Colleges also mentions her as a Matriculate. She does not figure anywhere in the Final selection List published in Greater Kashmir dated 19-02-2012.

In both, Tentative List (GK 25-12-2009) and Final List (GK 12-10-2010), Gulshan's junior Mubeena Akhtar (Govt Degree College Boys Sopore) figures at Serial No: 83. She is duly mentioned to have been engaged on 02-12-1996 and her qualification is duly shown as Matric. According to GK 19-02-2012, she has been selected and appointed as Gardener (at serial No:7).

Similarly, another of Gulshan's juniors, namely Mehfooza Jan, figures at Serial No: 97 in both (Tentative and Final) lists. Engaged on 01-07-1996 at M A Road, Mehfooza has been initially mentioned as Class 12th pass but her selection list finally makes it clear that her actual qualification was only Matric. Despite her wrong statement, she too has been selected and appointed as Lady Attendant in the regular Class IV grade.

Reached over telephone for his comments, Minister of Higher Education told Early Times that he would examine such injustices in detail and not only rectify the errors but also punish the guilty. Commissioner-Secretary Higher Education, Tanvir Jehan, maintained that irregularities committed would be removed and the genuine candidates appointed after verification of their complaints. She advised the complainants to submit their representation in detail to her in the next 15 days.

Tanvir asserted that "maximum care" had been taken to complete the exercise in a fair and transparent manner but did not rule out sinister interventions by lower level staff. She sought to make it clear that the exercise had been conducted under the supervision of Director of College who would rectify the errors, if any.

Director of Colleges, Mrs Muqbil Chisti said after verification of records that Gulshan Ara had been shown as "Middle Pass" in the Final list and thus dropped. When it was pointed out to her that not only her certificates and academic records but both, Tentative as well as Final list, shows her duly a Matriculate after all verifications, she assured that she would inquire into it and take stringent action against the officially involved in committing this fraud.

Canine Power

The editorial in the Kashmir Monitor is still unclear about how to stop and reverse the situation where dogs already outnumber people. Latest estimate shows that Srinagar city has nearly 100,000 stray dogs (second story)


City of Dogs

Not long ago, the Srinagar Municipal Corporation (SMC) had called a press conference to talk of some ‘major’ initiatives that would change the face of the city. While the citizens are still awaiting the summer capital’s facelift, the age old menace of stray dogs continues to remain unaddressed. The so-called initiatives of the authorities including the SMC action continue to remain on paper or in the planning stage.

The SMC had last year said the dog sterilization program would start in January 2012. While the people are wondering if the programme has started or not as the SMC has not yet issued a statement regarding its drive, the municipal corporation continues to remain tight lipped on the elimination of rabid dogs. The SMC continues to duck the question by either saying that the case is before the High Court or the ‘fear’ of animal rights activists. While the civil society had taken to streets against the menace on Saturday, the city dogs have always been in news. But still, no serious action has been taken in this regards. Shoot at sight orders to deal with the growing population of rabid and mad dogs in the Valley, the much hyped ‘Pied Piper’ programme that failed to take off and the so-called dog sterilization programme of the SMC.

Unfortunately, nothing seems to be working for the government when it comes to dealing with the stray dog menace. People of the city are still falling prey to dog bites and the memories of last year’s incident are still fresh in the peoples’ minds where a 10 year old died after slipping into river Jehlum after being chased away by the stray dogs at Zaina Kadal. The government’s action in this regard has been confined to paper only and the authorities have only been issuing statements to express its concern over the issue. After a youth died in Pampore town earlier last month due to dog bite, the divisional administration had issued shoot at sight orders to deal with the rabid and mad dogs. But then no further statement was issued by the government to shed light on the matter as to whether the concerned police officers had taken the said action or not. Similarly, the ‘Pied Piper’ programme that was floated across as some magic formula that would Srinagar free of dogs in a month too died a sudden death. While the Pied Piper’s ‘secret formula’ remained unrevealed, the authorities then labelled him a ‘circuswalla’ interested in ‘nautanki’ after he charged an exorbitant price for his proposed services. Now the government is back to square one. It has again started talking about its old method – SMC dog sterilization programme. A programme that never took off the way it should have as it too like other government’s schemes remained confined to paper only. With the animal rights activist watching closely every step of the state administration with regard to tackling the stray dog menace, the government seems to be scared of these activists.

The stray dog population in Kashmir is estimated to be over 10 lakh. The municipal authorities last year had planned a dog sterilisation and culling drive to curb the growing menace but this has been resisted by some animal rights groups and dog lovers.Over 10,000 dog bite cases have been registered in Srinagar city alone during the last couple of years. Some of the canine attacks have proved fatal for humans, including the death of a 10-year-old last month that had sparked public outrage. Some civil society groups have now threatened to undertake dog culling themselves if the government fails to control the menace and protect people.

Srinagar City Has 91,110 Stray Dogs

Srinagar: Srinagar City has 91,110 stray dogs and a pilot project of birth control, dog sterilisation and immunisation is being implemented to check the increasing menace, Urban Development Minister Nasir Aslam Wani informed this in the State Legislative Council on Wednesday.

He said that to control the increasing population of stray dogs in Srinagar a pilot project was being executed for dog sterilisation and immunisation as an immediate measure to control the increasing menace in the city.

Nasir said to check increasing population of stray dogs in Srinagar a tripartite Memorandum of Understanding has been signed by the Corporation with Animal Welfare Board of India (AWBI) and Dean, F.V.Sc and A.H.(SKUAST-K).

He said the Memorandum of understanding is signed for human stray dog population Management, through Animal Birth Control (ABC) and their Anti-Rabies immunization within Municipal limits of Srinagar.

He said that the corporation has decided to execute a pilot project of dog sterilization/ immunization as an immediate measure to control the increasing dog menace in the city. In this connection he said a proposal for setting up of Animal Birth Control Center at Shuhama which envisages construction of concrete walling with chain link fencing around 17.5 Kanals of land, setting up of 50 Kennels and Operation Theater with allied facilities costing Rs 103.90 lakhs has been formulated. In addition to this, he said construction work has already been taken in hand for construction of 25 Kennels, fencing around the land has been completed. He said as soon as the construction work of Kennels is completed, the immunization and sterilization programme of stray dogs shall be started.

Nasir said the total number of stray dogs estimated as per census is 91,110. He said the guidelines World Society for formulated the protection of Animals have been followed during the conduct of stray dogs census keeping local geo-climatic condition in view. This method has been endorsed by Animal Welfare Board of India (AWBI) and shown in its standard operating producers ( SOP), he added. (Rising Kashmir News)

A Treachery of Immense Proportions

Bashir is rightfully indignant at Government's plans to widen the Narabal Tangmarg Road (NTR) at the expense of beautiful chinars growing on both sides of the Gulmarg Road that will be cut down

How Long Will The Chinars Live?

Bashir Ahmad Gojree

Man’s place in environment is twofold- physical and the spiritual. The physical relationship entails interaction with all the living things and non-living objects that are a part of the environmental surroundings. The spiritual relationship, on the other hand, requires a set of the rules of conduct to be followed by man. These rules of conduct specify the duties and obligations towards other living species. The guiding principle in, both the cases, is that the environment should not be endangered by our activities.

“Even if there is only one tree full of flowers and fruits in a village that place becomes worthy of worship and respect." - Anonymous

Kashmir's famous Chinar tree (Platanus orientalis Kashmiriana), which has fascinated millions of tourists, over the ages, is an integral part of Kashmir's culture. In Kashmiri it is known as ‘BOUIN’ taken from a Sanskrit word ‘Bhawani’, the Goddess who has been worshipped in Kashmir since times immemorial. You can experience a cool breeze under the shadow of this majestic tree which is very conducive to health.

Chinar-Colony situated along the famous Gulmarg road, some 16 km from Srinagar, is bestowed with a line of lofty Chinar Trees as the colony owes its name to the presence of ample number of Chinars there here. These Chinars have become an essential part of the identity of the inhabitants of this colony.

The place exists in complete harmony with nature, endowed with an impersonal beauty, while the road assumes the shape of a green tunnel in the summers, golden in the autumn and grey in the winters. The cool shade of these Chinar trees, during hot summers, is a relief for anyone. But everything seems to be changing in the Chinar colony now!

A vicious circle of changes was initiated with the Narabal Tangmarg Road (NTR) widening which challenged the existence of these mighty chinars along the road. The NTR widening may be serving good purpose, but it was detrimental and severely damaging when it came to the majestic and magnificent Chinar trees standing along the road.

Though the government initiated the road widening programme and the administration cooperated, the conservation of such an important and critical tree heritage was ignored altogether. One is bewildered to see the fate of such a splendid heritage which was being crushed under the bulldozers and no one, neither the people, the activists, the media, and nor the administration heard the painful murmur. A horrific end to a heritage we should have been proud in preserving!

Besides adding to the pristine glory to the famous Gulmarg road, the peel-off, small twigs and the golden dry leaves of these Chinar trees are used by the locals to prepare domestic coal, used in the winters. Some birds like crows, eagle, owl, mynah etc., make their abode in these trees. These trees provide shelter to thousands of birds. It used to be a heavenly feeling to listen to the singing of these birds every morning and evening. But, Alas! It is a thing of past now.

NTR widening came as fatal blow to these Chinar trees and as the road was being macadamized along the parallel sides of these trees, they began to die. No doubt, the state government has imposed a ban on cutting the chinar and its lopping, and felling of a Chinar tree, where necessary, is permitted only against planting of five new trees of the same specie. But no steps were taken to save scores of trees from dying of road widening along the Narabal Tangmarg road. No new trees were planted. I believe that the Chinar trees in other parts of the valley are facing the same fate.

The tragedy is that we have ‘Chinar Development Authority’ which is in deep slumber and seem concerned only with the census of Chinar trees. They just release status report of the ever declining number of Chinar trees and do nothing to preserve or increase the numbers.

A good example for the authorities would be that of the seventh century King, Viram Deo, of Merta who, observing the tendencies of his subjects and their affection for Mango trees, ordered the preservation of mango trees in Jodhpur. It was a great source of success for the king and a mark of high respect and sense of belonging for the people. But alas! the present day representative in Kashmir do exactly the opposite.

Panacea for Kashmir

Finally, Dr. Padgoankar, Chief Interlocutor on Kashmir, speaks the mantra that he heard on 23 March 2011: http://kashmirforum.org/images/kashmir-conundrum.pdf


‘People in JK Yearn for Accountability, Transparency in Governance’

Umer Maqbool (Greater Kashmir)

Srinagar: A day after Union Minister and National Conference (NC) president Dr Farooq Abdullah made it clear that United Progressive Alliance (UPA) chairperson Sonia Gandhi is yet to take decision on the resignation of Public Enterprises Minister, Peerzada Muhammad Sayeed, the Centre’s chief interlocutor on Kashmir, Dileep Padgaonkar Sunday said the Congress high command should take a decision on the matter in sync with the expectations of people of Jammu and Kashmir, who yearn for accountability and transparency in governance.

“As far as my viewpoint is concerned, there is overall sentiment for accountability and transparency in matters of governance in J&K and therefore decision on the matter (Peerzada’s issue) should in tone with the expectations of the people,” Padgaonkar told Greater Kashmir over phone.

Padgaonkar headed three member team of interlocutors appointed in the wake of 2010 unrest in which more than 115 youth were killed in the Valley.

“We hope that Congress, which too wants transparency and accountability, will take a decision on Peerzada issue that meets the aspirations of people of Jammu and Kashmir,” he said.

Padgaonkar said Chief Minister Omar Abdullah has acted in good spirit by ordering an inquiry following the revelation by media that Minister helped his foster son to pass exam through cheating, but the position of Congress over the issue is still unknown.

“It was the media which came out with expose that Minister helped his son to pass matric exam by cheating. Subsequently Chief Minister called for an inquiry and it proved that Minister’s son was helped to pass the exam. The CM was expected to drop the Minister from his team. Later, there were news reports that Congress high command was opposed to taking any action against the Minister. However, Dr Farooq Abdullah has said that Congress high command is yet to take a final view on the matter,” he said.

Following the expose by this newspaper on January 30, about how Imam Souban, foster son of former Education Minister Peerzada Muhammad Sayeed resorted to unfair means to pass matriculation examination in 2009, the state government ordered a probe by the Crime Branch. In its revelation, CB said three papers of the Minister’s son carried two handwritings. Following the mounting public pressure, Omar Abdullah divested Peerzada of the Education portfolio he was holding since the formation of the NC-Congress coalition government in 2009. However, Peerzada continues to hold the portfolio of cabinet minister the government as Congress high command, according to him (Peerzada) refused to accept his resignation.

The Centre’s chief interlocutor added that nobody in Jammu and Kashmir wants to tolerate any wrongdoings of public servants and people want transparency and accountability in governance and administration.

“In all the interactions that the group of interlocutors had everyone has said that there is need for transparent, accountable and efficient governance,” he said.

Road Accidents Kill More Kashmiris Than Terrorists Plus Security Forces Combined

Srinagar lacks a red-light traffic management systems because authorities worry that public is not disciplined enough to follow the system. The results are obvious

Road Accidents Killed 2162 in 2 yrs

Umer Maqbool (Greater Kashmir)

Srinagar: As many as 2162 persons were killed and 18817 injured in about 12000 road accidents in Jammu and Kashmir during the past two years. According to official data, 1042 persons were killed and 8709 injured in 6136 traffic mishaps in 2010. In 2011, there was increase in the fatalities with 1120 persons having died; another 10108 were wounded.

Notwithstanding the deployment of entire traffic police manpower in the summer and winter capitals of the state, the cities witnessed 130 and 382 deaths respectively during the two year period. While Jammu district witnessed highest fatalities, Pulwama and Shopain district recorded lowest i.e, 13 causalities in the same time period.

There was no end to road deaths in the accident-prone Kishtwar and Doda areas of Chenab Valley as 156 lives were consumed in the twin districts having hilly and serpentine roads.

While Jammu and Kashmir Government is in deep slumber, the recent loss of life due to accidents in Chenab Valley and Srinagar-Jammu Highway has brought the issue of road safety on the forefront again, calling for immediate attention of the authorities.

People hold the loopholes in the transport mechanism responsible for the spurt in accidents. Talking to Greater Kashmir, Chairman of Legislative panel on road accidents, Muhammad Yousuf Tarigami, said that multiple factors were responsible for increase in casualties due to traffic mishaps.

“First of all, we don’t have a compressive road safety policy. And lack of coordination between different government agencies is responsible for traffic mess,” he said, adding that there were flaws in the mechanism of issuance of driving licenses in the state.

“There is perception in our state that you will get license on paying money. And there are instances which confirm this perception,” he said.

Tarigami added that shortage of manpower and absence of medical facilities including ambulances on Srinagar-Jammu Highway was another factor for massive human causalities.

He also disclosed that the report on road accidents prepared by the House Committee will be submitted in ensuing session of Assembly.

Inspector General of Traffic Police, Hemant Kumar Lohia, however, puts thrust on self-discipline to minimize the casualties.

“First and foremost step required for minimizing the casualties is self-discipline. Accidents cannot be wished away but can be reduced if people will follow guidelines and regulations laid by traffic department and other agencies. Better transport, better roads and technological advancements will be of more help than increasing the manpower,” he said, underlining the need for creating public awareness to avoid road accidents.

“We have seen that after every accident authorities make tall claims that they will take emergency measures forthwith to ensure road safety, but their oft-repeated assurances prove nothing more than hoax,” Muhammad Shaban, a Doda resident, said.

“Roads & Buildings Department, Beacon and National Highway Authority of India is responsible for the loss of lives as accidents have been reported mostly in the areas where the condition of roads is pathetic. Besides, there is no protection (caution signals) on the turns and blind curves in other areas,” he said, adding, “Not to talk of roads in other districts of the state, even the vital Srinagar-Jammu Highway and roads in Doda, Kishtwar are in shambles,” Shaban said. When contacted, Minister for Transport, Qamar Ali Akhoon, said that a number of measures were in the offing to minimize accidents.

“We would put tight system in place for the issuance and renewal of driving licenses and directions in this regard will be issued forthwith. Besides, two driving institutes will be established in Jammu and Srinagar shortly,” he said.

The Rich are Really Rich

A recent study by the Indian chamber of commerce, ASSOCHAM, found the greatest disparity in India between the rich and the poor exists in Kashmir. Now we have hard data that the amount of the value added tax (VAT) collected in Kashmir exceeds even larger and richer states in India like Gujarat, Maharashtra, Tamil Nadu and Punjab. Amazing!



JK Realized Highest VAT Revenue in India: Rather

Rising Kashmir News

Jammu: Jammu and Kashmir’s VAT revenue has increased to about 41 per cent which is the highest in India,said Minister for Finance and Ladakh Affairs, Abdul Rahim Rather said here Monday.
“The State Finance department is continuously reviewing its fiscal updates by virtue of which the State’s VAT has increased to about 41 per cent which is highest in the country. This year the total tax revenue has touched a high of Rs. 4800 cr as compared to Rs. 3400 cr during last year,” said Rather.

He was addressing a gathering of chartered accountants at the foundation stone laying ceremony of a building for Jammu and Kashmir branch of Institute of Chattered Accounts of India (ICAI).
Eulogizing the contribution of Chartered Accounts in banking, corporate financial management and tax administration, Rather said their professional advice and expert role in formulation of policies, legislation and standardization and improvements in accounting practices are indispensible for governance in these areas.

Rather said J&K is regular beneficiary of the contribution of Chartered Accountants in updating of audited balance sheets of its public sector undertaking (PSUs) and their help in our VAT administration.

He added that the much needed facility of a building for the Institute of Chartered Accounts of India at Jammu will prove beneficial for the local youth to venture in the field of Chartered Accountancy and updating the knowledge and the acumen of its members.
He said accountancy in a fast changing global business environment is a tough professional challenge and imparting of skills especially relevant for international trade, WTO, GATT etc are not only beneficial for the professionals themselves but also essential for promotion of our International trade and Commerce.
Besides, Economic Advisor to J&K Government, Jalil Ahmad Khan, who was Guest of the Honour, Vice President ICIA, CA. Subodh K. Agrawal Chairman, NIRC, CA. Rajesh Sharma, Convener land and Building Committee, CA. R. K Gupta and Chairman, J&K Branch of ICAI, CA. Ajay Sawhney were also present on the occasion.

Extending best wishes to the ICAI and NIRC, the 2nd largest accounting body in the World, in seeing much greater heights in their profession, which he described sacred and credible profession, the Minister also wished the J&K Brach of prosperous and fulfilling future so that promising locals who want to update their knowledge could be benefited by this facility at their door-steps.

Rather said the Chartered Accountants Act 1949 is among the most self contained and compact pieces of legislation aimed at self regulating the profession of the Chartered Accountants of India in a professional manner.

“It is hard to conceive as to how our nascent economy would have otherwise grown into a world giant of today.”

J. A. Khan highlighted the role of Chartered Accountants in securing public interests as well as in economic welfare, by way of watching and auditing the accounts and updating balance sheets in PSUs.

He said their expertise could also be utilized in the State Government’s ongoing initiatives towards re-structuring of its PSUs to make these profitable.

Vice President of the ICAI and Chairman NIRC of ICAI assured full financial assistance for construction of the State-of-Art building for Chartered Accountant’s fraternity at Jammu.
They said the ICAI has by now developed 122 branches all over the country with an overseas presence as well adding that the membership of the institute has reached to 1.9 lakh with 10 lakh students presently enrolled by the institute.

Protecting an Important Asset of Human Beings

Dr. Tabish provides a global perspective on basic healthcare systems, and suggests a way forward with an eye to ensure needs of the underserved and deprived sections of the society are met

(Professor Syed Amin Tabish, 50, was born in Srinagar. He graduated from Government Medical College Srinagar, and did his postgraduation from the All India Institute of Medical Sciences (AIIMS), New Delhi. He obtained doctoral and postdoctoral degrees from the University of Bristol (England), the Royal College of Physicians of London, and the American College of Physicians (USA). Dr. Tabish has been providing academic and administrative leadership to premier medical universities and hospitals, and recently worked as Professor of Medical Education cum Project Director for four Medical Colleges & two University Hospitals, and advised other medical and nursing colleges in Saudi Arabia. He is presently working as Medical Director cum Head, Department of Hospital Administration and Chairman Accident & Emergency Department at Sher-e-Kashmir Institute of Medical Sciences, Srinagar. He is also an External Examiner, AIIMS, and National Board of Examinations for the award of Diplomat National Board, New Delhi. Professor Tabish has authored more than a dozen medical and hospital administrative books and has 350 Research publications in international medical journals and about 500 literary publications. He is on the Editorial Board of several medical journals besides being Editor-in-Chief of the International Journal of Health Sciences. He represented India in “The World Health Assembly” held at Dallas, Texas, during 1998 (first medical scientist from India). Dr. Tabish has been advocating new or changing roles of doctors and other health professionals in response to emerging or refractory social problems, under-served populations, inequalities, rising costs of care, continuous quality improvement, need for community involvement in resolving imbalances between the preventive, promotive & curative services.)


Designing a World Class Healthcare System

Since the dawn of civilization health care has been a focus of public and government interest. As early as 1700 B.C.E., Hammurabi, ruler of Babylon, developed laws on health care matters that included access to services, payment for care, and quality control. Nations throughout the world are faced with growing demands on their health care systems, often accompanied by diminishing abilities to satisfy and pay for all the health care needs and wants of their citizens. The health care sector of the global economy is huge: Its issues are many and they are exceedingly complex. Arguments over trade-offs between social solidarity versus personal autonomy, public versus private health care financing, public versus private provision of health care services, and the need for high-quality medical care versus more basic levels characterize health care debates in virtually every nation. Yet, to move forward, we must understand these enormously complicated problems and find a path that moves us toward executable health care policies.

Health Ideals
All modern, well-developed health care systems share a common goal for those who depend on their services: hope for full and healthy lives. The personal importance of this goal inevitably means that health care is much more than an ordinary economic good or service. Good health is a state of being that is necessary for each of us to have the opportunity to fully express our human selves and to be able to reach our human potential. Our health care system, whether public or private or mixed, is the social and economic expression of support for our individual good health. Health can be seen as a means, a foundation for achievement, as a first achievement itself, and a necessary premise for further achievement.

Ethos and Politics Shape a System's Potential
How medical care "wants," "needs," and personal expectations are fulfilled in a nation's health care system is driven by a number of non-medical considerations. Ethics and politics are two considerations that have profound effects on how a nation organizes the financing and provision of medical care for its citizens. The body politic of nations differs in their societal ethic. The distinction between social solidarity and personal autonomy is an important driver underlying a nation's choice between public and private health care systems. The United Kingdom adopted its public health care financing and delivery system as a "reward" to itself following the turmoil and pain of World War II. Social Insurance and Allied Services laid the foundation for creation in the United Kingdom of a National Health Insurance (NHI) program.

Goals for Health Care Systems
As means to an end of good health, those responsible for stewardship of health care systems adopt goals for their work. These goals (cost, quality, and access) are "ideals" that citizens and those who steward health care systems debate and strive to reach. Actual health care system performance quite often falls short of fulfilling these goals. One major reason for a performance gap is that assessing and measuring cost, quality, and access as well as their interrelationships and trade-offs are quite difficult.

Health Systems Structure
All health care systems must perform an array of functions designed to measure objectives, the ultimate objective of a health care system being health itself. To work effectively, a health care system must perform some high level functions. Delivering services is the most visible of these functions. However, in order to deliver services, a health system must first be effective at creating resources through investment and training. Funds for resource creation and service delivery are an essential lubricant; therefore, health systems must also arrange financing. Funds must be collected, pooled, and ultimately used to purchase needed goods and services. Government is ultimately responsible to its citizenry for the performance of its health care system through the nation's political system. Health care systems function to provide for population health needs. Fulfilling these needs is the system's objective. Health is clearly the most basic objective. WHO (2000) notes: ". . . while improving health is clearly the main objective of a health system, it is not the only one. The objective of good health itself is really two-fold: the best attainable average level-goodness-and the smallest feasible differences among individuals and groups-fairness. Goodness means a health system responding to what people expect of it; fairness means it responds equally well to everyone, without discrimination". Based on this notion of how health care systems perform, WHO adopts three fundamental objectives. These are: Improvement of the health of the population served, Responsiveness to citizen's expectations of their "needs" and "wants" and Financial fairness in providing protection against the costs of poor health.

Health Care Systems Performance
The world's healthiest overall population is Japan's, with 74.5 years DALE (Disability Adjusted Life Expectancy). Twenty-four nations have a DALE of 70.0 years, which can be considered as a "world-class" health outcome. The United States ranks No. 24 at 70.0 years, the United Kingdom ranks No. 14 at 71.7 years, and the 15 EU member nations average 71.4 years DALE. At the other extreme, the world's least healthy populations are found in Sub-Sahara Africa: Sierra Leone ranks No. 191 at 25.9 years and Niger ranks No. 190 at 29.1 years DALE. There are vast differences in DALE between the healthiest and least healthy nations of the world community. Most of the difference is explained by survival rates and not by years alive with disability. In the healthiest nations, disability-adjustments reduce life expectancy by about 10%. For example, life expectancy at birth in Japan is 80.0 years, compared to 74.5 years of DALE. In the least healthy nations, this adjustment amounts to 20% of life expectancy. Sierra Leone has 34.3 years life expectancy versus 25.9 DALE. The health profiles of populations in the healthiest nations also are very different from those of the least healthy nations. WHO measures this burden of disease using the number of disability-adjusted life years (DALYs) lost to various diseases. Developed nation's burden of disease is heavily caused by chronic diseases. Developing nations' burden of disease is heavily weighted toward infectious disease, diseases of childbirth, and accidents. There has been a great deal of thinking done about how to address this morbidity profile. Much of this disease burden is amenable to basic public health intervention. Clean water, sewage treatment, basic prenatal and postnatal care, accident prevention, and other simple interventions can greatly reduce these health problems.

Highly Effective Health Care Systems
Health care in the United States is delivered almost exclusively by private sector providers. Many hospitals are owned and operated by for-profit companies; others are not-for-profit or charitable institutions. Physicians and other health care workers are either independent practitioners or work for private-sector health care institutions. The U.S. mix of public and private sector responsibilities has its characteristic strengths and weaknesses. At 70.0 years DALE, the United States is one of the nations with "world-class" health outcomes. The other outstanding characteristic of the U.S. system is its responsiveness: It ranks No. 1 in the WHO survey. Health Attainment (DALE) captures the effectiveness of a national health care system in satisfying its population's health care "needs": Higher DALE is clearly associated with a healthier population. Responsiveness measures capture the intangible health care "wants" that arise from the importance of health care to individuals' sense of well- being: For a given level of health attainment (DALE), a health care system that is more client-oriented and patient-centered will rank higher in responsiveness. The U.K. health care system has world-class health outcomes, with little variation across its population, and high marks for financial fairness. There is, though, one large negative to this system: It receives relatively low marks for its responsiveness. Developed nations with world-class health outcomes (DALE > or = 70.0 years), which include both U.S. and U.K. health care systems, all spend "enough" on health care to satisfy their populations' health care "needs." Additional spending on health care tends to improve responsiveness (i.e., "wants") more than health outcomes (i.e., "needs"). Health is so essential and sensitive to individuals that even the best health care systems have difficulty managing their public's concerns and expectations.

An Ideal Health Care System
Designing a world-class health care system inevitably requires choosing between or mixing public and private approaches, most particularly in financing. Which choice or mix makes most sense depends in large part on the characteristics of public and private health care financing. Understanding the significant differences in the performance of public and private markets requires a digression into the economics of insurance markets. Health care systems need enlightened stewardship. The government stewardship of health care systems is necessary. The need for stewardship of public health care plans is clear. Stewardship is not, though, limited to public programs. Without enlightened regulation of health insurance (i.e., government stewardship), universal access to medical care is virtually unattainable. The base of an ideal system is a universal health care program providing for citizens' medical care "needs." Universal access is consistent with a social ethic of social solidarity in providing at least basic medical care services to all citizens. Having defined differences between health care "needs" and "wants," an ideal public universal health care system should cover population "needs" and leave funding for and coverage of population "wants" to an adequately regulated private-voluntary health insurance market. There needs to be a seamless, non duplicative interface between universal needs- based and voluntary wants-based parts of the health care system. Those charged with stewardship of the system need to design this interface carefully, which also is not an easy task. The health care system must have adequate medical care resources, and it must be flexible and able to adapt to new health care technologies and new medical care needs. As medical research continues to drive new technology, and as countries grow richer and their citizens value more and more medical care, so too will the boundary between "needs" and "wants" change. An artificial heart is an example of this dynamic. As artificial heart technology improves, will this extremely expensive medical intervention be made available and, as it becomes more effective and common, will it ultimately change from a "want" to a "need?" This single example should amply demonstrate the ethical, political, technical, medical, financial, and emotional issues that will continue to challenge health care systems.

Reorientation in Policy imperative
India spends only 17.3% on public health services as compared to UK that spends 95.6%, the US 44.1% and China 25%. An authoritative appraisal of health sector firmly blames the government for treating this sector shabbily. While the Union government budgetary allocation for health over the last decade has stood still at 1.3%, in the States it has dropped to 5.5% from 7%. Though Health is a state subject, there are many areas where the Centre has scope for intervention. It has a critical role to influence the health policies of the states, especially in disease prevention and health promotion. The poor are hard hit by ever-increasing price of drugs and lack of access to essential drugs. According to an estimate, India would require additional 7.5-lakh beds, from the current 15- lakh beds by 2012. These additional infrastructure facilities may require an estimated additional investment of anything around 10, 00,000 crore. A major part of this expenditure would have to be borne by the public sector as the low and middle income groups cannot afford to bear the cost of treatment in private health facilities. The government will have to promote the growth of private, social and community insurances to improve healthcare affordability for the people at large. Lessons can be learnt from Korea, Singapore and Brazil where insurance has become quite popular and helped the cause of healthcare. Indian pharmaceutical industry though quite big has not helped the poor people in getting adequate healthcare in rural areas. Government has an essential role to provide basic healthcare to underserved and deprived sections of society. Health is one of the most important assets a human being has. A higher awareness of the health of the people is necessary if sustainable growth is pursued. Factors like productivity and schooling are as important as health for the development of a country, where this last factor is sometimes not taken care of with the importance that it deserves. Health can affect not just the economic health of a person, but of an entire nation. It is important to include investment in health as a tool of macroeconomic policy, due to the fact that differences in economic growth rates between countries have been significantly explained by health differences, showing that investment in health improves economic growth and is one of the few feasible options to destroy poverty traps. If we don’t do it, who will?

A Review of the New Drug Policy in J&K

Dr. Geer explains the strengths and weaknesses of the newly approved policy by the J&K Government 

(Dr. Geer Mohammad Ishaq, 39, was born in Srinagar. He did his schooling from the Shaheen Public School, and his senior secondary graduation from the Gandhi Memorial College, Srinagar. He attended the Al-Amin College of Pharmacy, Bangalore, completing both the B. Pharma and M. Pharma degrees. Subsequently, Dr. Greer completed his Ph.D. in Pharmacology from the Department of Pharmaceutical Sciences of the University of Kashmir. He started his career as a drug inspector, shifting subsequently to the Department of Pharmacology, University of Kashmir, where he is presently serving as the senior Assistant Professor. In his leisure time, he enjoys writing, listening to music and networking.)


Approved Drug Policy of J&K Government – A Review

After sixty years of inaction, government of Jammu and Kashmir finally approved a draft drug policy for the State. Draft has been approved in a meeting of the State cabinet under the chairmanship of Chief Minister on January, 12th, 2012 and is now all set to be placed in the forthcoming budget session of the legislative assembly. Draft of the drug policy was prepared by the Government of J&K in 2009 but was grossly lacking in as many as twenty five highly significant issues. Draft had specified no policy for spurious drugs, against drug addiction, for drug licensing, for unwanted drug withdrawal and disposal, for unethical promotion and prescribing practices of drugs, for drug pricing, in-house Quality Control testing etc. It was only after a committee framed by the Civil Society Forum (CSF) Kashmir led by this author had a four-hour long marathon meeting with several senior functionaries of the health department including Commissioner-Secretary Health on November 2nd, 2011, that some of these issues were addressed and appropriate remedial measures included in the draft. This contribution of CSF has been acknowledged in the memo prepared for the cabinet. At first, Government officials were extremely reluctant to make any changes in the draft but finally on persistent motivation and sound explanation provided by CSF team, Commissioner-Secretary Health promised to include most of the suggestions.

SELECTION OF ESSENTIAL DRUGS:

Draft Drug Policy approved by the cabinet of ministers in J&K envisages that the Department of Health & Medical Education shall appoint an Expert Committee known as the State Drug Committee which would be responsible for initially preparing and subsequently updating the essential drug list every two years for the hospitals in public sector. The Committee will comprise of Clinicians, Pharmacologists, Microbiologists, qualified Pharmacists and independent experts in the field besides senior functionaries of the Department like the Principals of Medical and Dental Colleges, Directors of Health Services, Controller of Drug & Food Control Organization etc. The Committee shall be headed by the senior-most Principal of Government Medical Colleges in the State. Further a separate drug committee with appropriate composition would be constituted in respect of drugs pertaining to Indian Systems of Medicine. The drugs selected by this committee shall be identified and listed by their generic names or International Non-proprietary Names (INN) only. The State essential drug list will be subsequently categorized according to the levels of health care facilities like primary, secondary and tertiary and will be revised after every two years so as to reflect therapeutic advances and changes in cost, resistance pattern and public health relevance.

However there is one discrepancy in this key feature of the approved policy. Memorandum for approval of drug policy for J&K prepared for submission to the cabinet by the Commissioner/Secretary to Government, Health and Medical Education Department clearly reads at S. No. 8, page 4 that “two working groups, one each for Jammu and Kashmir division were constituted under the chairmanship of the respective principals of Government Medical Colleges to prepare a draft drug policy besides a State level committee under the chairmanship of the then Commissioner/Secretary to Government, Health and Medical Education Department with members from each division to finalize the draft drug policy for the State. Memo reads that these working groups also prepared a draft State Essential Drugs List and Complementary Drugs List. This Essential Drugs List comprised of 383 drugs.”

Pertinently, Civil Society Forum (CSF) Kashmir in its meeting with senior functionaries of the health department had pointed out that since the draft drug policy of 2009 envisaged that State essential drug list will be revised after every two years so as to reflect therapeutic advances and changes in cost, resistance pattern and public health relevance and given the fact that two years have already passed ever since State essential drug list appended to the draft drug policy 2009 was prepared, a new State essential drugs list must be prepared in tune with National List of Essential Medicines (NLEM), 2011 for the purpose of this policy. However it was not suggested that EDL prepared by the experts keeping in view local requirements of the State should altogether be replaced by the NLEM 2011. Consequently NLEM, 2011 appended with the approved drug policy is the one that caters to the whole country in general and not to the J&K State in particular. It would have been more pertinent to revise the State EDL in consonance with diseases endemic to this region and the local needs of our hospitals.

PROCUREMENT OF ESSENTIAL DRUGS:

Owing to the friction between Health Ministry and the Ministry of Medical Education in the State, the idea of having an autonomous corporation on the pattern of Tamil Nadu Medical Supplies Corporation (TNMSC) as was mooted in the draft drug policy of 2009 has been skipped in the final approved draft. Unrevised draft had endorsed that the drugs included in the essential drug list shall be centrally procured through an autonomous, transparent, accountable and free from constraints mechanism on the pattern of TNMSC which has achieved unprecedented success in ensuring timely availability of quality drugs and has therefore been recommended to be adopted for procurement of drugs, not only by the Government of India but by the World Health Organization too. Unrevised draft had envisioned that the procurement, storage and transportation becomes easier, more transparent and more accountable when it is done through an autonomous Corporation and also reduces the tendency to invest funds in unutilized and slow moving stocks because the Corporation was expected to invest in drugs which have a good take off. This model was believed to facilitate the minimization of stock outs and expired stocks, and ensure availability of essential drugs throughout the year as per the actual requirements of the health institutions. Under such a dispensation, the Health and Medical Education Department was supposed to advise on medicines to be procured but the decisions on procurement would have completely rested with the corporation.

Ignoring all these assertions made in the unrevised draft, State Government has finally declared in the approved draft that the existing procurement mechanisms of drugs & supplies shall be improved with a view to ensuring timely availability of quality drugs. Approved policy also envisages to make the detection of pilferages/wastages/expired stocks easier and for this purpose, an appropriate Management Information System shall be evolved and a web-based e-procurement model developed. It reaffirms that the objective is to put in place an effective system of procurement of essential drugs by generic names to ensure timely availability, good quality and reasonable cost. However existing procurement mechanisms are too flawed and inefficient to improve so drastically overnight as required under approved drug policy provisions. Existing system has completely failed so far in keeping quality drugs available at hospital drug counters throughout the year.

As a matter of fact, provisions relating to generic drug prescribing cannot be a success or even a reality unless and until procurement procedures are very well defined in the policy. Unfortunately, dropped idea of having an autonomous corporation on the pattern of TNMSC could have helped a great deal in streamlining the drug procurement process and ensuring round the clock availability of quality generics at hospital counters. Drug policy approved by the State Government specifies no detailed procedures for drug procurement and their quality assurance and unless that part is settled between the two squabbling ministries of Health and Medical Education, generic drug prescribing cannot work on expected lines. Selvaraj and Nabar have suggested in India Health Report 2010 that an efficient procurement supply chain is based on the fundamental principle of transparency in the process of selection & quantification of drugs and the procurement process – which includes tendering process, bid opening process, award conditions, payment mechanisms and quality control procedures. Lack of efficiency in any one of these areas can lead to sub-optimal procurement, resulting in a shortage of supply. Further it is likely to produce uncompetitive behavior among suppliers, leading to fewer choices of suppliers and higher prices of drugs. Therefore in larger public interest, Government must decide on this issue as soon as possible so that the approved drug policy does not remain confined to the shelves of the government secretariat.

GENERIC DRUG PRESCRIBING:

There are widespread myths and misconceptions among common masses, pharmacists, chemists as well as doctors regarding generic drugs and these misgivings have only been compounded by the spate of misinformed newspaper columns against generic drug use published after clearance of the drug policy by the State cabinet. After years of research and worldwide consultation, World Health Organization (WHO) has clearly recommended generic drug prescribing as one of the core strategies to promote rational use of medicines across the globe. Percentage of medicines prescribed by their generic names is in fact one of the primary/ core drug use indicators used by WHO for assessing quality of drug utilization in any country. In fact there is a separate Department for Essential Medicines and Pharmaceutical Policies at the WHO. Using an essential medicines list makes medicine management easier in all respects; procurement, storage and distribution becomes easier with fewer items; prescribing and dispensing becomes convenient for professionals if they have to know about fewer drugs and on top of all, availability and affordability of drugs to poor patients visiting government health facilities will drastically improve upon generic prescribing. Concept of Essential Drugs List as a whole is aimed at making the best use of limited resources particularly in resource-poor countries like India. Procurement of fewer drugs in larger quantities results in more price competition and economies of scale and also to better supply of drugs, rational prescribing, reduction in costs and finally to better health outcomes.

Worldwide, developing as well as developed nations are shifting to generic prescribing and this is showing phenomenal gains in every aspect of drug use, that is why more than 75% prescriptions in US and more than 50% prescriptions in UK contain generic drugs at present. However it is understandable that situation in our part of the globe is no match to that in US or UK, which results in numerous apprehensions about the success and implications of generic drug prescribing. Even though generics have proved to be a big success everywhere else, in our part of the globe where there is large scale corruption and drug markets are poorly regulated showing little compliance with norms, enforcing genuine generic prescribing and sale is a huge challenge for the Government agencies. To address such predicaments, examples of several Indian States like Delhi, Tamil Nadu, West Bengal, Rajasthan, Himachal Pradesh, Chhattisgarh, Kerala, Karnataka, Uttarakhand can be cited that have shifted to generic prescribing in Government hospitals successfully and tremendous benefits have been recorded in every aspect of drug use. Same is the case with another resource-constrained country like Bangladesh that has also made good progress in this direction. Initially there is skepticism but with effective implementation of the policy, all problems are gradually sorted out. However necessary pre-requisite is that there has to be effective and foolproof implementation of the policy by the government agencies, devoid of any corrupt practices. If proper implementation of the policy fails, generic prescribing cannot be of any help.

Ensuring high quality of generic drugs purchased by the Government is an inherent component of the approved drug policy outlined under procurement provision. If the Government follows standard guidelines of pre-qualification and post-qualification of suppliers and strictly adheres to the technical specifications as has successfully happened in case of Tamil Nadu Medical Supplies Corporation, there is no reason why Government can't procure good quality drugs. However the controversy surrounding the autonomous corporation V/S procurement directorate in J&K has a potential to mar the entire spirit of the rational procurement policy.

There are concerns that generic drugs are not available in open markets and patients living in far-flung areas may face problems in refilling their prescriptions. These issues can be taken care of by the prescribing physicians who may prescribe as per the patient's short-, mid- and long-term needs so that patients are able to keep adequate stocks with them depending on their distance from the healthcare centers. Keeping in view exceptionally low cost of these drugs, it won't be a problem for the patients to purchase a few extra doses. Further all patients with common, speciality or rare diseases have to revisit their physicians for consultation when they can refill their prescriptions. Adequate number of drugs listed in State EDL will have to be kept available at all district level healthcare facilities throughout the State so that patients do not face any difficulty on account of their access and availability. Simultaneously, as per the approved drug policy, the State Essential Drug List will be categorized according to the levels of health care facilities like primary, secondary and tertiary. There are some drugs which though not listed in the essential drug list are required for specific diseases/exceptional cases. Keeping this in view, approved drug policy provides that a supplementary drug list shall be drawn by the State Drug Committee and a provision of grants not exceeding 10% of the allocated budget for drugs shall be earmarked for purchase of drugs in the supplementary drug list.

Having said that, Drug Policy is actually aimed at addressing the medication related needs of majority of population with common ailments, availing Government health facilities. Number of formulations available in the market at present is more than 20,000 which are mostly needless. For almost all the diseases, 348 drugs are enough to cater to all drug related needs. This number is as per National List of Essential Medicines, 2011 and not as per our local needs. Apprehensions expressed by certain quarters that the generic drug prescribing in Government hospitals will discredit prescribing physicians from exercising any choice of brands and at the same time it will empower the pharmacist to replace the prescribed generics with any generic of his own choice depending on his profit margins. Such fears can come true if the government machinery fails to make all drugs listed in the State essential drug list available in adequate quantities throughout the year at drug counters within the hospitals. However if Government can successfully implement the drug policy provisions and never allow stock-outs within hospital pharmacies, then this won't happen. As per the inherent design of the approved drug policy, all prescriptions will be filled at hospital drug counters and none of the prescriptions whether belonging to in- or out-patients will need to be dispensed at drug stores outside the Government hospitals. This can temporally affect the business of drug stores outside the Government hospitals but with the passage of time, they will adapt to the changing scenario. Moreover such fears have propped up in other Indian States too when generic drug policies were implemented there, but eventually everything got streamlined on expected lines. Once an ambience of generic prescribing prevails, all hiccups and hurdles will be overcome automatically. For the time being provision of generic prescribing of drugs is applicable only for public sector hospitals because majority of poor people visit these hospitals for treatment and that is where they need quality medicines at affordable prices. Affluent can afford to purchase branded medicines in private sector.

WARE-HOUSING AND DISTRIBUTION:

Unrevised draft of the drug policy prepared in 2009 had mentioned that the government shall establish modern warehouses at divisional and district levels under the proposed J&K Medical Supplies Corporation keeping in view the State’s topography, climatic conditions and issues of accessibility and that the capacity of warehouses/stores would be in line with the requirement to ensure constant supply of drugs to the healthcare institutions they are feeding. However, surprisingly this provision has been dropped in the draft approved by the State cabinet. One fails to understand what was wrong in establishing warehouses at divisional and district levels when the Government has decided to procure drugs centrally and then distribute to various district level hospitals. Pertinent to mention here that Madhya Pradesh government’s centralized drug procurement policy failed on account of non-availability of adequate drugs storage and transportation facilities at district level and consequently they had to revert back to decentralized procurement in their revised drug policy of 2009. CSF’s specific suggestion that the drugs should be stored as per good storage practices and in accordance with FEFO (first-expiring-first-out) and FIFO (first-in-first-out) fashion has not been incorporated verbatim, however, approved drug policy envisages that the drugs shall be distributed under proper transportation conditions, ensuring safety and proper delivery and that the distribution will be done in an appropriate and timely manner to maintain availability throughout the State. However, CSF’s suggestion that pre- and post-shipment quality control testing/analysis of drugs should be done through random sampling on all stocks has been ignored. Thankfully approved draft has incorporated CSF proposal that the proper recall and disposal procedures shall be followed as per standard guidelines.

FINANCING:

Approved draft of the drug policy envisages that the J&K government will provide allocations for procurement and supply of drugs for all types of institutions – Primary, Secondary & Tertiary and that the Department of Health & Medical Education shall be responsible for projecting the cost of drugs required from time to time. However CSF suggestion that Government needs to specify how drug budgets will be estimated and what will be the minimum per capita per annum expenditure on drugs has not been considered.



QUALITY ASSURANCE AND REGULATION:

Draft drug policy approved by the State cabinet duly recognizes that Controller, Drugs & Food Control Organization in the State is responsible for implementing the legislation and regulations on pharmaceuticals to ensure quality, safety, efficacy of drugs and accuracy of product information and therefore said organization needs to be strengthened through a capacity building process by augmenting infrastructure, manpower and financial resources. Drug Testing Laboratories would also be strengthened by providing equipment, qualified analysts and other requirements as may be consistent with the workload. Approved drug policy has accepted CSF suggestion that average testing time and annual testing load of Government laboratories shall be fixed for greater accountability and the rules relating to cosmetics shall be enforced and laboratories notified for their testing purpose. However following important proposals put forth by Civil Society Forum to strengthen DFCO, J&K have not been included in the approved draft:

a. Adequate communication, transportation, accommodation, and legal assistance facilities should be provided to the inspectorate staff in all districts besides according them gazetted cadre and proper authorization for inspecting AYUSH drug stores. All provision of Drugs and Cosmetics Act relating to AYUSH medicines listed under Chapter IV-A should be enforced.

b. J&K Government should mobilize all necessary resources to make Drug Inspectors available at Block level rather than at tehsil level in the State.

Similarly approved draft provides that surveillance on the quality of drugs available in the market shall be kept by collecting samples and taking further action according to law. However CSF suggestion that in-house quality control cells should be established in all hospitals where drugs lifted by random sampling should be tested for their quality has not been considered.

Further in light of the fact that several conflicting yet alarming reports about the magnitude of spurious medicines in Indian markets ranging from as low as 0.25%, as per Government claims up to a whopping 35% as claimed by several independent groups like ASSOCHAM, CII, OECD, EC etc, it is difficult to hazard a guess about the extent of this unscrupulous trade in J&K. Therefore CSF had suggested that a statistically designed, scientifically implemented, State wide survey should be conducted by collecting samples from every nook and corner of the State and testing them for their quality and authenticity, to measure the extent of this menace in J&K State. Government of J&K has not deemed it worthwhile to consider and accept this proposal on the grounds that drug inspectorate of the Drug and Food Control Organization, J&K as part of their routine duties regularly lift drug samples for testing and there is no need for a separate survey in this regard. Approved draft does make a mention that the surveillance on the quality of drugs available in the market shall be maintained by collecting samples and taking further action according to law.

MEASURES TO CURB SPURIOUS MEDICINES:

In regard to curbing the menace of spurious/counterfeit/sub standard/misbranded/ adulterated drugs in the State approved draft of the drug policy includes CSF suggestions that an intelligence-cum-legal cell shall be established in the office of Drug and Food Control Organization, J&K to facilitate busting of spurious drug rackets and their prompt prosecution and that the efforts shall be made to provide incentives to informers giving information about spurious drugs. It also mentions that adequate steps shall be taken to ensure proper implementation of drug regulations especially with regard to offences related to adulterated or spurious drugs. However further suggestions put forth by CSF in this regard as shown below have not been included in the approved draft:
a.Special courts shall be designated to try the cases of spurious drugs
b.Effective networking system between neighboring States shall be developed.
c.Necessary changes in law shall be made to award severe and deterrent punishments as afforded under law to those dealing with spurious drugs, making the offences cognizable and non-bailable in the light of similar provisions in Narcotic Drugs and Psychotropic Substances Act.
d.A distance of at least 500 meters shall be maintained between two successive shops.
e.Drug sale licenses shall be issued only to persons holding diploma or degree in pharmacy from a recognized/duly approved university/institution. Necessary amendments shall be made in the relevant Acts to enforce this provision.
f.Preparation of dossiers of suspected dealers and manufactures shall be a perpetual exercise. Such dealers will be black-listed and their licenses cancelled.
g.Manufacturers shall be encouraged to have their own anti-counterfeit drug strategies like RFID, QRC etc, better surveillance and efficient complaint handling system.
h.Effective interaction between the stakeholders i.e. industry and regulators, industry and consumers, trade and regulators and medical professional and regulators, will be developed



DRUG LICENSING POLICY:

Even though approved drug policy declares that efforts shall be made to rationalize number of drug licenses and to strictly enforce the provisions of the J&K Pharmacy Act, Samvat 2011 and the rules framed there under, shockingly it makes no commitment that Education Regulations will be enforced in the State and thereafter further registration of unqualified people as Registered Pharmacists will be stopped that has of late turned into a non-stop nuisance in the State. Surprisingly commitment to this effect has been made in the memo for submission to the State cabinet of ministers but the same is missing in the approved draft of the drug policy making the government’s intentions doubtful since illegitimate registration of unqualified people shall continue, as per J&K Pharmacy Act unless and until Education Regulations are not enforced in the State. In this regard following suggestions put forth by the Civil Society Forum have been completely ignored.

“Central Pharmacy Act of 1948 should be enforced in the State to replace J&K Pharmacy Act 2011 (Samvat) and the J&K Pharmacy Council should endeavor to constitute its executive committee and frame Pharmacy Education Regulations and implement them as soon as possible so that minimum standards can be prescribed for colleges and institutes offering diploma or degree courses in Pharmacy. This will make sure that nobody enters the profession of pharmacy without earning a legal qualification. Further the constitution and scope of J&K Pharmacy Council shall be broadened, making it all-inclusive by enrolling professionals from academia, hospitals, industry and trade as its members”. Some kind of sabotage by certain vested interests in this regard cannot be ruled out.

POLICY IN RELATION TO AYUSH DRUGS:

Approved draft provides that the regulatory laws related to quality control of AYUSH drugs shall be examined and suitable amendments in the said regulations shall be made, wherever necessary. However following additional measures suggested by CSF in respect of drugs belonging to AYUSH systems of medicine have been dropped on the pretext that a separate policy for such drugs shall be devised by the Government in due course of time:

a. A committee comprising of traditional health practitioners and healers, and experts in pharmacognosy, toxicology and related fields should be constituted to study and guide the various activities with respect to AYUSH drugs.

b. The health conditions that can be treated with these traditional systems of medicine should be identified.

c. An appropriate methodology and technology for the identification, development and production of medicinal items used by the traditional systems of medicine should be developed.

d. Scientific studies to evaluate the quality, safety and efficacy of traditional and herbal medicines should be fostered and promoted.

e. All practitioners of traditional medicine systems as well as the public should be encouraged to remain alert to adverse reactions to traditional and herbal medicines and to notify them to the Drug Information Centers and the nodal center for drug information in the State.

f. Cultivation and research of medicinal plants, should also be encouraged and promoted.



Had J&K government included these proposals, use of drugs belonging to Alternative System of Medicine would have been streamlined to a very large extent even if Government had any plans to bring in a separate policy for such drugs.



DRUG ADVERTISEMENT AND PROMOTION:

This particular clause of the approved drug policy envisages that in order to prevent risks of misuse and marketing of drugs by quacks, wherever required, laws would be made and strengthened and that this would also help in regulating commercial advertising and marketing of drugs. Hence any advertisements and promotion of drugs will be required to provide complete drug information. However approved drug policy of J&K government does not provide any policy framework in relation to curbing the menace of unethical promotion and marketing practices of drugs by pharmaceutical companies that often lead to unethical prescribing by some unscrupulous doctors. In this regard following suggestions put forth by CSF have been dropped by the Government

a) All drug promotional practices of pharmaceutical companies and prescribing practices of doctors should be in accordance with Dec.,2010 amendments of the MCI code of Medical Ethics (professional conduct, etiquette and ethics Regulations), 2002 and the prescribers should be made to adhere to these guidelines in letter and spirit.

b) Authorities of government hospitals, particularly teaching hospitals, should ensure that the activities and conduct of medical and pharmaceutical sales representatives are in conformity with standard ethical norms and do not, in any way, hamper routine patient care.

c) Drug Policy should ensure rational prescribing practices by all doctors whether in public or private sector, rational dispensing practices by pharmacists and rational use of medicines by the consumers in an integrated and seamless manner.

d) Promotion-making claims of pharmaceutical suppliers should be reliable, accurate, truthful, informative, balanced, up-to-date, capable of substantiation and in good taste.

e) Product information of all kind should be scientifically valid and evidence-based.

f) Offering, soliciting or accepting inducements of any kind, monetary or material (except free samples of product in modest quantity) for promotional purpose should not be indulged in.

g) Prescribing doctors or dispensing pharmacists should not accept support or assistance of any kind conditional upon obligation to promote a medicinal product.

h) Professional societies, educational organizations may accept partial sponsorship from the pharmaceutical companies for holding scientific meetings and symposia, but this should be clearly stated at the meetings and in proceedings. Care should be taken to ensure that the sponsorship in no way affects the quality of scientific deliberations in the meeting.

LOCAL MANUFACTURE OF PHARMACEUTICALS:

In order to promote self-sufficiency, the State government envisages to encourage, promote and support local manufacturers of pharmaceuticals in the approved drug policy however this is not a good drug procurement practice as per international norms and well-established standards since it tilts the balance in favor of the local manufacturers and discourages reputed pharmaceutical concerns from outside the State from participating in competitive bidding process. Moreover we don’t have sufficient manufacturing concerns operating from within the State. On the pattern of Bengal Chemicals and Pharmaceuticals Limited, Rajasthan Drugs and Pharmaceuticals Limited, our State Government too needed to establish a Government-owned pharmaceutical manufacturing unit in accordance with cGMP regulations. However, this suggestion put forth by CSF has not been included in the approved draft by the Government

HOSPITAL PHARMACY SERVICES:

Good news is that Government has accepted CSF suggestion and declared in the approved draft that clinical pharmacy services shall be introduced in all major hospitals for the benefit of the patients and in all the hospitals of the State, Drugs and Therapeutic Committees shall be established and made effectively functional, which will be responsible for reviewing drug utilization and promoting rational use of drugs. Furthermore a State level Drugs and Therapeutic Advisory Committee shall also be constituted to monitor the activities of the drugs and Therapeutic Committees of the hospitals and evidence-based Standard Treatment Protocols shall be developed as the basis for training, prescribing and drug supply. Approved drug policy also envisages that in order to enhance safety of drugs used in hospitals, to monitor and document adverse drug reactions and other adverse events among patients, pharmacovigilance centers will be established in Government hospitals. Further expertise and human resource in pharmaceutical field will be developed to support the successful implementation of the policy and appropriate in-service training programs will be designed and implemented to enhance their skills. Another prospective measure that has been adopted in the approved policy is the establishment of Drug Information Centers in the Government Medical Colleges to provide appropriate and unbiased drug information to all stakeholders and to publish a State level formulary annually in line with the WHO/national norms.

However CSF suggestion that all hospitals be directed to devise their own hospital drug management policies for efficient management of their resources and drug supplies and the suggestion that in-house Quality Control cells should be established in every major hospital as part of their comprehensive Quality Assurance system have not been included in the approved draft. Services of qualified pharmacy graduates must be made available in all division, district and sub-district level hospitals of the State.

MEASURES TO CURB DRUG ABUSE:

Government of J&K has endorsed CSF suggestions that sale, storage, use of drugs and record keeping specified under Schedule X of the Drugs and Cosmetics Act, 1940 shall be supervised and monitored effectively by the inspectorate staff working under Drug and Food Control Organization, J&K and special checking squads under the leadership of Deputy Controllers will be constituted to undertake periodic inspections in this regard. Approved draft also mentions that Schedule-H drugs shall be strictly dispensed on the prescription of Registered Medical Practitioners. However following suggestions put forth by CSF to curb the menace of drug abuse have not been considered worth inclusion in the final draft by the Government



a. License to sell, stock and distribute drugs pertaining to Schedule X should be restricted to dealers with absolutely spotless track record and should not be issued to those indulging in any sort of unlawful activities.

b. Workforce of the Narcotics Control Bureau should be augmented and its nodal center established at Srinagar.

c. In compliance with NCBI directions, a multi-disciplinary Coordination Committee under the Chairmanship of Chief Secretary or a senior Secretary should be established for regular interaction with various Central and State agencies & to receive support and grant-in-aid assistance from Narcotics Control Bureau of India (NCBI).

d. The State should set up an Anti Narcotics Task Force under an IG level officer with duties and responsibilities duly demarcated.

e. Proliferation of drug stores should be discouraged and easy availability of substances of abuse should be reversed.



BLOOD BANKING AND TRANFUSION POLICY:

Regarding this issue of vital significance approved draft of the J&K Government has accepted CSF suggestion that the best practices will be followed in Blood Banking and Transfusion of Blood. However following important measures as suggested by CSF have not been discretely mentioned in the approved draft.

a. Procedures of blood banks e.g. blood collection, processing, compatibility testing, storage, component separation, transfusion of blood and blood products and all other related activities shall be practiced as per the rules and regulations under the Drugs and Cosmetics Act 1940 and the Drugs and Cosmetics Rules 1945 and in accordance with relevant statutory guidelines.

b. In keeping with the constant needs and constraints, special provisions shall be made to facilitate availability of blood and blood products through a substitute storage system, in peripheral areas where good blood banking system is still in the process of development.

c. An expert Committee shall devise Standard Operating Procedures and oversee the functioning of all blood banks and peripheral storage facilities to ensure and facilitate the above goals.

FUTURE POLICY AMENDMENTS:

Government has decided that the approved policy document shall be reviewed and revised at appropriate intervals based on the need but at-least once every five years but it does not make any commitment that all stake-holders from hospitals, academia, regulatory bodies, trade, industry and Government departments shall be involved in the process of review or amendment of the policy. Approved drug policy provides that the State would endeavor to provide financial incentives to promote rational use of drugs apart from regulatory and managerial strategies. However, it has not included CSF suggestion that a State level empowered group of experts should be constituted to overlook rational use of medicines, ethical drug prescribing, and dispensing and promotion practices in hospitals as well as in the community at large.

(Originally published in the Physicians Academy online journal.)

The Doyen of Kashmiri Drama

Betab introduces a Kashmiri cultural icon who was awarded the Padma Shri award on 26th January 2012

(Mr. Brij Nath Watal "Betab", 55, was born in Akingam, Anantnag district. He attended the Government High School in Achabal, and completed his pre-professional studies at the Amar Singh College, Srinagar. He received a Master's degree in Political Science from the Indira Gandhi National Open University (IGNOU), New Delhi. He is presently employed as a broadcaster/journalist by the All India Radio (AIR), New Delhi. Mr. Betabhas published three poetry collections, and received a National Award for poetry. He has traveled to Central Asia, and attended many national and international seminars. He is a regular contributor to half a dozen magazines, and is the honorary editor of the Hindi edition of the "Koshur Samachar." Mr. Betab is a member of J&K Academy of Art, Culture and Languages (JKAACL) subcommitte on Kashmiri language, a member of the Bhartiya Jnanpith (Language Advisory Committee), and a member of the Jammu and Kashmir Urdu Academy. He is also associated with various Sahitya Academy projects, and served as its jury. In leisure time, he enjoys writing and reading poetry, oriental studies and Shaivism.)

Moti Lal Kemmu - The doyen of Kashmiri drama

Born in the year 1933 at Zaindar Mohalla Srinagar, Moti Lal Kemmu was attracted to dancing in his early childhood. 'Dancing came to me naturally', says he. And because of this inclination towards dancing, the young Moti, (as he was fondly called by his parents), was introduced to stage at a very young age, where initially he would dance and latter was offered small roles too. 'The talented dancer of yester years late Gopi Nath from Anantnag , who was popularly called 'Gopeh Bache', had a tremendous influence on me', remembers he.

Parsi theatre was prevelant in Kashmir at that time and dramas that were being performed , particularly the Folk dramas like the Akanandun of Tarachand Bismil also influenced him.
'By the time I graduated in the year 1953 , I had developed a liking for painting as well. I even participated in a few exhibitions. This was the time when Cultural Congress Movement was very active in Kashmir.'

But despite this passion for the brush, young Kemmu wanted to be trained in Dance and drama. So after completing graduations, he got admissions at Baroda University to study drama and dance.
At Baroda Kemmu learnt drama and dance under the guidance of the great Guru Sh.Sunder Lal Gangani. It was the year1957.However life at Baroda and back home was not smooth for him. He had to leave Baroda.

Back in Kashmir, he was overwhelmed by the desire to study. So he joined Hindi M.A.class after returning from Baroda. But had to leave University of Kashmir half way to fend for some livelihood.

'The job was more important than the studies as it guaranteed our sustenance, says he. It was 1958'. Kemmu moved from one department to another. Starting from a monthly salary of 60 odd rupees he earned about 250 per month within a span of two years.

A regular salary could not kill his passion for Dance and drama . With this inner haunt, he felt incomplete. Till he ultimately got a national scholarship and landed again at Baroda. 'The national scholarship changed the course of my life', says Kemmu with some satisfaction, looking back today.

Having studied drama and dance at Baroda with the legendary Gujarati playwright Chandravadan Mehta, he returned to Kashmir to study and experiment with the popular folk form of Kashmiri drama called 'Band Pather'.

Kemmu made 'band pather' (Folk drama) his medium of narrative, where he combined the folk technique with the modern art form and used this synthesis to reflect the contemporary issues.
In the initial period Moti Lal Kemmu wrote in Hindi. "I wrote my first Drama at Baroda in the year 1962. It was called 'Darpan Antpur Ka.'" My second drama was titled 'Sandhya beeti'. My third play, that I wrote while I was at Baroda University was titled 'Nangee'. The Play 'Nangee' was staged and presented by the department of Drama in the early part of 1964."
'Back in Kashmir he shifted to kashmiri language and wrote his first Kashmiri plays 'Trinov' and then wrote 'Tshay' in the year 1965.In 1968 he wrote 'Manzil Nike' (Toddler in the cradle).
Upto 1975, Kemmu had published four Drama collections. These are 'three one act plays', 'Trinov' , 'Lal be drayas lo-lare' and 'Tshay.'(Shadow).

Tshay (Shadow) written in 1972 was probably the first play that reputed him as a dramatist. The drama is based on human tragedy where in a human being loses his faith and all that he believes in. Kemmu sahib told me in an interview some time back that the idea of this drama occurred to him from the closure of Jammu Srinagar national highway. The passengers stranded at Banihal during winters gradually lose faith in the state administration and the Beacon that is unable to keep to keep the road open. Finally they even stop praying to God as they lose faith in the entire system.Kemmu synchronized this idea with the historical plot where the Kashmir king Lalitaditya met a horrible end.

He interlaced Lalitaditya's tragedy with the difficulties being faced by a common man in today's times. He depicted how faith is lost. When the king could just not do anything to save his soldiers, who while praising their master had termed his toe nails as the mirrors.
From history Kemmu moved to folk and wrote another drama woven through the thread of folk tale Hemaal Naegrai and Band Duhai. In Band Duhai the contemporary issue of militancy is tackled withsensitivity. This play is based on folk tale Aknandun. The drama depicts the helplessness of a common man is Kashmir. The story goes like this. A particular child is killed by militants . The mother does not mourn the killing, as she believes that the father who plays the character of a Jogi in the play Akanandun and brings back to life the killed Akanandun, will resurrect his own child as well. But the Jogi(The husband) explains to the lady that what he does in the drama is a piece of fiction. It is not possible in real life. The lady is shattered and becomes hysterical.She lectures the audience to convey how downtrodden people like the folk performers in Kashmir have suffered during militancy.

Other than writing dramas Kemmu sahib also contributed in establishing folk theatres Kashmir. In 1964, he along with Late Mohmad Subhan Bhagat established the Bhagat Theatre Akingam and Arnimal theatre, that is dedicated to the memory of great poetess Arnimal in her native village Palhalan .
With 18 full length drama books to his credit and the coveted Sangeet Natak Academy award and many state awards in his kitty, other than the just announced coveted Padma shree award, Sh. Kemmu today is a living legend.

A trained graduate from the Baroda University, Sh. Kemmu the octogenarian dramatist has dedicated his entire life to folk theatre in Kashmir, both its writing as well as staging. His greatest contribution is that he writes in his native language Kashmiri that not only enriches the language and drama in it and preserves a tradition but also brings esteem for other writers of Kashmiri prose and poetry.

Valley of Drug Addicts - So Says the UN

Females constitute only 7% of Kashmir's drug addicts, and yet nearly 70% of the student community is into drugs


No Help for Kashmir’s Female Drug Addicts

Sana Altaf

Srinagar(IPS) - Drug abuse, known to be widespread among youth in India’s northern Kashmir state, is now showing a new trend whereby teenage girls and women are increasingly turning into substance abusers and addicts.

That young women and college-going girls are abusing substances, especially toluene, a common thinner, is testified to by officials at the de-addiction centre run by the police control room in Srinagar.

Toluene abuse or 'glue sniffing' has become widespread because the chemical is readily found in paints, petrol, varnishes, lacquers, paint thinners, adhesives, glues, rubber cement and shoe polish.

"The abuse of toluene is getting very common in Kashmir because it is easily available," says Dr. Areeb Malik at the police de-addiction centre here.

"Getting other drugs is a bit more difficult for girls than buying ink remover or polish," said Malik, adding that females as young as 13 years have been found involved.

Doctors say the major causes for drug addiction among girls are peer pressure, stress, family disputes, failure in life, examination stress, love affairs and psychiatric disorders.

What authorities at the police de-addiction centre find worrisome is the total lack of facilities for female drug addicts. "We do not admit female drug addicts," said Malik.

Female addicts may seek consultation at the centre, but are then left to their own devices. "We prescribe medicines to female addicts but they are never kept under complete supervision which is most important for de-addiction," said Malik.

Typically, female drug addicts do not come back after the first consultation. "The doctors are always uncertain if they are following prescriptions or whether they have given up drugs," says Malik.

Besides lack of facilities, social stigma restricts women from seeking rehabilitation or treatment.

"Keeping in view the social stigma which female drug addicts face, it is important to set up a de-addiction centre for them," said Sameena (name changed), a 22-year-old college student and former drug addict.

Sameena said she began with glue sniffing "for fun" during her school days and then moved on to opiates. Fear of social stigma and lack of facilities forced her parents to take her outside Kashmir for treatment. Sameena has been under medication for 11 months now.

Mohsin Ali, an official at the stress management cell of the police de-addiction centre, set up in February 2011, said 298 calls were received from drug addicts until November 2011, including 11 from females.

"We once received a call from a teenage girl who said she, along with 18 of her female friends, wanted to quit drugs. But, we never heard from them after that," Ali told IPS.

Yasir Ahmad, a social worker at the centre, said there was a need for de-addiction centres devoted to treating both males and females. "There was a time when Kashmir had one addict from each district but now there are more than one in a single family."

The state health department does not gather or maintain data on the status of drug addiction in Kashmir, adding to the worries.

"The direct impact of addiction is social disintegration. It splits families, friends’ circles and subsequently society. It is commonly known that addicts live in isolation," said A.G. Madhosh, psychologist and former professor at the University of Kashmir.

Madhosh said youth on drugs may physically live in the same house with their families, but live alone emotionally. "They do not care about what happens to their near ones and these insensitivities extend towards society."

"Additionally, their poor performance in education or at work is burdensome to society. We can easily imagine the fate of a society with a large number of addicts," Madhosh said.

The problem of drug abuse in Kashmir was highlighted by the United Nations International Drug Control Programme survey in 2008 which showed that there were more than 70,000 drug addicts in Kashmir, 4,000 of them women.

That survey also revealed that 65 to 70 percent of the student community in Kashmir was into drugs and that 26 percent of female students were involved in drug abuse. More than 70 percent of addicts fall in the 18-35 age-group.

Leading psychiatrist Dr. Mushtaq Margoob in his study, ‘The Menace of Drug Abuse in Kashmir’, conducted in 2008, found that more than 200,000 people in the Kashmir valley which has a population of four million people were on opiates.

Margoob’s study, made public in 2009, is currently the only authentic report available regarding drug abuse in Kashmir. No survey has since been undertaken in the state. (Inter Press Service)